Why is heme onc not considered a lifestyle speciality?

[Duke1K]

---

Members don't see this ad.

I retired from research after I matched and I can't wait to never do academia again. If 250k-300k is what I was gonna make, I wouldn't have applied.

The earning potential in academic heme/onc is not bad. At the full professor level, depending on the setup, the spread is quite wide. The basic scientists with one clinic day a week currently make 350K+, but if you're a good scientist and spin off a company as many do in the Bay Area, that's how you get a nice kickback (at least in the 7-8 figures range) for years of low pay. The clinicians with two clinic days a week +/- inpatient make 450-650K+, and the highest earner in our department made almost 1M (in benign heme, no less).

 

[solidonc2020]

GI, then onc. High income regardless of location is main reason.
If I can go back to med school then rads hands down.

Having recently completed a job search through the mid-Atlantic, I will agree that onc salaries right now are high (typically 500k+ with RVU bonuses) even in desirable areas (mid-sized metros) around here. They're ridiculously high (700k-1M+ total comp) in rural locations, including areas near coasts with good weather, etc in the Southeast.

ETA this obviously does not include purely academic jobs where the pay lags significantly behind.

 

[Legend of Link]

The earning potential in academic heme/onc is not bad. At the full professor level, depending on the setup, the spread is quite wide. The basic scientists with one clinic day a week currently make 350K+, but if you're a good scientist and spin off a company as many do in the Bay Area, that's how you get a nice kickback (at least in the 7-8 figures range) for years of low pay. The clinicians with two clinic days a week +/- inpatient make 450-650K+, and the highest earner in our department made almost 1M (in benign heme, no less).

How do you make that much in benign heme?!

 

[Legend of Link]

I suspect a large part is due to the fact that most rheum are in a metropolitan area where the income is actually <300k. I used to be academics in major metro and I was making <200k. I don’t have data for this, but I would bet that rheum is one of the specialties with the highest gap (as a %) between rural and metro income. For comparison, the GI guys here pull 700-800k, but the GI in major metro areas in my state make 500-600k. The onc guys here make 600-700, but the ones in major metro make 450-500k.
This is why I said before I would NOT do rheum again. Doing this specialty basically forces you to work in rural/semi rural. There are good things about living here but it’s never a good thing to limit your geographic flexibility.

Out of all the fellows around the time I trained, none are working in rural/semi rural.
You also have to add in the fact that a lot of rheum out there are on mommy-track or have a high earning spouse and don’t really care to hustle for $

• Why the higher reimbursement in the rural/semi-rural area? Is it because of higher RVU for hospital employed positions since no one wants to live in the rural/semi-rural areas? Since private practice is "eat what you kill" do you see a person working in metro vs a person working in rural/semi-rural area making the same amount of money?

How feasible is it to see 40-50 patients a day in rheuma since once you figure out a stable regimen it's on autopilot ? Seems like in outpatient specialties the more volume the more profit you generate.

 

[Duke1K]

How do you make that much in benign heme?!

My suspicion is that the inpatient service was severely understaffed and he hustled quite a bit that year, plus 100K supplemental income from pharma/research. Little known secret is that benign hematologists are in very high demand in academics (at our institution, most consulted service by far) and pay can be quite good.

 

[bronx43]

• Why the higher reimbursement in the rural/semi-rural area? Is it because of higher RVU for hospital employed positions since no one wants to live in the rural/semi-rural areas? Since private practice is "eat what you kill" do you see a person working in metro vs a person working in rural/semi-rural area making the same amount of money?

How feasible is it to see 40-50 patients a day in rheuma since once you figure out a stable regimen it's on autopilot ? Seems like in outpatient specialties the more volume the more profit you generate.

It’s a huge misconception that one can easily just amass 40-50 pts a day. There simply aren’t that many true rheumatic diseases out there. Now, if you want to see a bunch of OA pain patients and give them narcotics then 40-50 is obviously doable but then you become a pain clinic. Furthermore, with the cost of care (high deductible plans), patients don’t want to come see you. Each time they pay out of pocket for the visit and labs - just for you to feel their joints and say “keep taking your meds.”
No show rates nowadays are high and existing pts often drop off your schedule like flies. Obamacare really wrecked outpatient volumes and it’s really taking full effect now.

The main reason rheum makes very little in bigger cities is that there simply aren’t enough pts to go around. Most can’t hit huge rvu production and just languish at 4k-5k rvu and end up <300k.
In rural areas, there’s little competition so docs can more reliably hit high volume to make 400-600k.
The comp per RVU is probably moderately higher in rural but that’s not where most of the difference comes from.

Infusions are a diff discussion altogether. I know dozitgetchahi group shares infusions but this is actually incredibly rare. Most groups are eat what you kill and the new doc never eats much since infusions are rarer by the day.

 

[Legend of Link]

It’s a huge misconception that one can easily just amass 40-50 pts a day. There simply aren’t that many true rheumatic diseases out there. Now, if you want to see a bunch of OA pain patients and give them narcotics then 40-50 is obviously doable but then you become a pain clinic. Furthermore, with the cost of care (high deductible plans), patients don’t want to come see you. Each time they pay out of pocket for the visit and labs - just for you to feel their joints and say “keep taking your meds.”
No show rates nowadays are high and existing pts often drop off your schedule like flies. Obamacare really wrecked outpatient volumes and it’s really taking full effect now.

The main reason rheum makes very little in bigger cities is that there simply aren’t enough pts to go around. Most can’t hit huge rvu production and just languish at 4k-5k rvu and end up <300k.
In rural areas, there’s little competition so docs can more reliably hit high volume to make 400-600k.
The comp per RVU is probably moderately higher in rural but that’s not where most of the difference comes from.

Infusions are a diff discussion altogether. I know dozitgetchahi group shares infusions but this is actually incredibly rare. Most groups are eat what you kill and the new doc never eats much since infusions are rarer by the day.

I actually like seeing OA and RA but I do see your point. Obamacare screwed up medicine.
However, I kept hearing that there is a rheumatology shortage and it's going to be worse since a lot of the rheumatology doctors are getting old and about to retire. wouldn't that mean less competition and more patients?
Would then recommend doing allergy since there is a lot more patients with rhinitis and allergy then autoimmune diseases?
Or endo since diabetes is so prevalent?
If considering volume as revenue generator. But i know allergy makes bank from their shots and skin testing

 

[Doc mu]

GI, then onc. High income regardless of location is main reason.
If I can go back to med school then rads hands down.

Does GI do that much better than onc? I thought GI/cards/pulmcc/hemeonc essentially made the same +/- 50k, I would also say GI lifestyle is pretty hard from what I've seen

 

[osprey099]

Does GI do that much better than onc? I thought GI/cards/pulmcc/hemeonc essentially made the same +/- 50k, I would also say GI lifestyle is pretty hard from what I've seen

For all comers, yes, GI makes more than onc. But everything is highly variable depending on practice setting, productivity bonus structure, geographic location etc.

I would say that GI and Cards call is significantly worse than heme-onc call across the board, regardless of any of the above aforementioned variables

 

[osprey099]

I actually like seeing OA and RA but I do see your point. Obamacare screwed up medicine.
However, I kept hearing that there is a rheumatology shortage and it's going to be worse since a lot of the rheumatology doctors are getting old and about to retire. wouldn't that mean less competition and more patients?
Would then recommend doing allergy since there is a lot more patients with rhinitis and allergy then autoimmune diseases?
Or endo since diabetes is so prevalent?
If considering volume as revenue generator. But i know allergy makes bank from their shots and skin testing

I'm assuming you are a medicine resident or med student currently. I would pick a specialty based on your interest and if you think you would be happy practicing that specialty for at least 20+ years.

Don't pick a specialty based on perceived demand/income. All of that can change very quickly. Onc compensation is good right now, but can be different 5-10 years from now. You can make good money in any medicine subspecialty if you play your cards right

 

[osprey099]

It’s a huge misconception that one can easily just amass 40-50 pts a day. There simply aren’t that many true rheumatic diseases out there. Now, if you want to see a bunch of OA pain patients and give them narcotics then 40-50 is obviously doable but then you become a pain clinic. Furthermore, with the cost of care (high deductible plans), patients don’t want to come see you. Each time they pay out of pocket for the visit and labs - just for you to feel their joints and say “keep taking your meds.”
No show rates nowadays are high and existing pts often drop off your schedule like flies. Obamacare really wrecked outpatient volumes and it’s really taking full effect now.

The main reason rheum makes very little in bigger cities is that there simply aren’t enough pts to go around. Most can’t hit huge rvu production and just languish at 4k-5k rvu and end up <300k.
In rural areas, there’s little competition so docs can more reliably hit high volume to make 400-600k.
The comp per RVU is probably moderately higher in rural but that’s not where most of the difference comes from.

Infusions are a diff discussion altogether. I know dozitgetchahi group shares infusions but this is actually incredibly rare. Most groups are eat what you kill and the new doc never eats much since infusions are rarer by the day.

Do pp rheum groups own their own infusion? Or do you have to ship patients to oncology infusion centers?

Our onc pp oftentimes will administer like remicade for the local GI practices and IV hydration/antiemetics for ObGyns who don't have their own infusion

 

[osprey099]

this person is probably a tenured full professor with perhaps a Dean/associate dean title to their name. They are getting paid because of their title, not because of any clinical work they do

How do you make that much in benign heme?

 

[osprey099]

The earning potential in academic heme/onc is not bad. At the full professor level, depending on the setup, the spread is quite wide. The basic scientists with one clinic day a week currently make 350K+, but if you're a good scientist and spin off a company as many do in the Bay Area, that's how you get a nice kickback (at least in the 7-8 figures range) for years of low pay. The clinicians with two clinic days a week +/- inpatient make 450-650K+, and the highest earner in our department made almost 1M (in benign heme, no less).

In my northeast coast major metro, "clinical full professors" get 350-400. Assistant professors/instructors get <200k. Clinic for everyone is 2 full days/week

 

[Duke1K]

this person is probably a tenured full professor with perhaps a Dean/associate dean title to their name. They are getting paid because of their title, not because of any clinical work they do

Yeah like I said, these numbers are for full professors. This person certainly has a title but not dean-level. He makes more than the heads of our department and others, because of his clinical volume +seniority.

 

[IM_to_ortho_hopeful]

GI, then onc. High income regardless of location is main reason.
If I can go back to med school then rads hands down.

Why radiology hands down?

 

[bronx43]

Do pp rheum groups own their own infusion? Or do you have to ship patients to oncology infusion centers?

Our onc pp oftentimes will administer like remicade for the local GI practices and IV hydration/antiemetics for ObGyns who don't have their own infusion

Most pp groups will own their own infusions. Without infusions, these groups would collapse instantly. You simply can’t pay the overhead on these practices without substantial ancillaries coming in. The $130 you get from a 99214 is laughable when you have 8 staff members and their benefits.

 

[bronx43]

Why radiology hands down?

I hate the customer service aspect of medicine. I daydream about being able to sit by myself in a dark room reading imaging without having to deal with pts and their whims. All the while making $600k…

 

[bronx43]

I actually like seeing OA and RA but I do see your point. Obamacare screwed up medicine.
However, I kept hearing that there is a rheumatology shortage and it's going to be worse since a lot of the rheumatology doctors are getting old and about to retire. wouldn't that mean less competition and more patients?
Would then recommend doing allergy since there is a lot more patients with rhinitis and allergy then autoimmune diseases?
Or endo since diabetes is so prevalent?
If considering volume as revenue generator. But i know allergy makes bank from their shots and skin testing

The shortage in rheum thing has been discussed since 2015 when the workforce study came out. Total horses***. There’s no real shortage. Not even close. Maldistribution? Sure.

Endo def has more patients than rheum. Huge wait in most places to get with one.

Allergy is saturated af. Even in my semi rural neck of the woods there are somehow 3 allergists. Their schedules aren’t filled. I see wayyy more pts than they do. I guess they have their shots, but talk about a one trick pony…

 

[IM_to_ortho_hopeful]

I hate the customer service aspect of medicine. I daydream about being able to sit by myself in a dark room reading imaging without having to deal with pts and their whims. All the while making $600k…

Why not go back for radiology residency bro? It’s only 4 years

 

[whoknows2012]

FWIW all this talk about compensation in academics-agree with the above. If you hustle in academics and your institution/division offers incentive RVU bonuses it almost doesn’t matter what the base is. There are people I know early in their career (ie <5 years) pulling in hefty bonuses (>100k). In addition for the more mid career folks, I can’t say I know people pulling in 1M but def 750k+.

If you sit back and do bare minimum (ie no consulting no ad boards etc) but see patients 2 days a week, be the PI on 1-2 studies as well as some clinical research and don’t do any extra inpatient time then it’s quite the lifestyle speciality but also with very little earning potential

 

[bronx43]

Why not go back for radiology residency bro? It’s only 4 years

Not enough CMS funding unfortunately. I looked into it.
Had I gone back after IM then maybe it could have worked but def not after fellowship.

 

[osprey099]

Why not go back for radiology residency bro? It’s only 4 years

Rads is not a specialty you can just get a spot in. Its very competitive for fresh grads, let alone someone who is mid-career in a completely unrelated field

 

[bronx43]

Rads is not a specialty you can just get a spot in. Its very competitive for fresh grads, let alone someone who is mid-career in a completely unrelated field

This is true as well but I had an in due to a connection, but didn’t matter because of funding.

 

[IM_to_ortho_hopeful]

Not enough CMS funding unfortunately. I looked into it.
Had I gone back after IM then maybe it could have worked but def not after fellowship.

CMS funding doesn’t matter, if a program wants you they will take you. The way the funding works depending on program is you have direct funding and indirect funding, only your indirect funding may be reimbursed at 50-75%. But if any GME program is over their certain aliquot of residents all residents would be funded this way as well. Fellows are funded similarly. Works better for larger programs that already have 1000 residents.

There are huge amounts of medicine trained people who go into radiology, including some legends like Jeffrey Galvin who is a pulmonologist (Galvin, Jeffrey | University of Maryland School of Medicine)

As far as competitiveness goes, frankly it doesn’t matter. Bronx is a medicine trained subspecialist, this alone is enough to set him apart from the crowd. That being said it’s not like you are a medical student, if you apply and don’t get in your worst case scenario is going back to your 500k/yr job lol

 

[bronx43]

CMS funding doesn’t matter, if a program wants you they will take you. The way the funding works depending on program is you have direct funding and indirect funding, only your indirect funding may be reimbursed at 50-75%. But if any GME program is over their certain aliquot of residents all residents would be funded this way as well. Fellows are funded similarly. Works better for larger programs that already have 1000 residents.

There are huge amounts of medicine trained people who go into radiology, including some legends like Jeffrey Galvin who is a pulmonologist (Galvin, Jeffrey | University of Maryland School of Medicine)

As far as competitiveness goes, frankly it doesn’t matter. Bronx is a medicine trained subspecialist, this alone is enough to set him apart from the crowd. That being said it’s not like you are a medical student, if you apply and don’t get in your worst case scenario is going back to your 500k/yr job lol

Thanks, that’s good to know. Maybe the program (small community program) was just pulling my leg. But it’s a pretty solid connection and I would be surprised if this close friend was not being truthful. Maybe they didn’t want to hurt my feelings after seeing my CV lol.
Either way, it makes way more sense for me to just knock out a few more years of 500k then go part time. I’m almost there…

 

[onconc]

The earning potential in academic heme/onc is not bad. At the full professor level, depending on the setup, the spread is quite wide. The basic scientists with one clinic day a week currently make 350K+, but if you're a good scientist and spin off a company as many do in the Bay Area, that's how you get a nice kickback (at least in the 7-8 figures range) for years of low pay. The clinicians with two clinic days a week +/- inpatient make 450-650K+, and the highest earner in our department made almost 1M (in benign heme, no less).

Any idea on actual total compensation numbers in the bay area in non-academic ?

AFAIK, it is usually between 450k (kaiser) up to 700k (in other places). With average RVU conversion being around 100 or 110. But would love to hear more actual numbers.
thanks

 

[IM_to_ortho_hopeful]

Thanks, that’s good to know. Maybe the program (small community program) was just pulling my leg. But it’s a pretty solid connection and I would be surprised if this close friend was not being truthful. Maybe they didn’t want to hurt my feelings after seeing my CV lol.
Either way, it makes way more sense for me to just knock out a few more years of 500k then go part time. I’m almost there…

Yeah at the point you’re at you’re basically asking the question of FIRE vs. becoming a radiologist, at which point it’s a hard choice!

I think radiology would be a great retirement gig, read prelims from anywhere in the world, work 3-4hrs a day whenever you want. You won’t max reimbursement but at this point you won’t care, just want to keep the brain running a bit.

Regarding the small program, yes the small program would likely be interested in the extra funding of like 25k a year; but any old university of X program likely wouldn’t care. I’m rooting for you if you decide to make the transition after you retire, to be honest you may be the first US boarded rheum/radiologist in all of history, which would be a cool career. From a program perspective I have no doubt you would be a top candidate because the program would be training an excellent radiologist, and perhaps one of the most unique radiologists, who would be able to better correlate clinically MSK radiographs than you? Lol

 

[Duke1K]

Any idea on actual total compensation numbers in the bay area in non-academic ?

See my previous post about this in this thread, then add 200-300K throughout the course of a career

 

[whatup2016]

For comparison:

heme/onc - employed
Midwest.
200k-ish population
4.5 days/week.
500k + 30k bonus + RVU bonus over 5000 RVU.

Can easily pull in 600+ by seeing 15 pts/day.

 

[RustBeltOnc]

For comparison:

heme/onc - employed
Midwest.
200k-ish population
4.5 days/week.
500k + 30k bonus + RVU bonus over 5000 RVU.

Can easily pull in 600+ by seeing 15 pts/day.

this offer isn't so great. 5000 wrvu in hem onc - if legit - is a ton of work even if the patient #s aren't overwhelming. This is 700k worth of work in 2024.

 

[dozitgetchahi]

• Why the higher reimbursement in the rural/semi-rural area? Is it because of higher RVU for hospital employed positions since no one wants to live in the rural/semi-rural areas? Since private practice is "eat what you kill" do you see a person working in metro vs a person working in rural/semi-rural area making the same amount of money?

How feasible is it to see 40-50 patients a day in rheuma since once you figure out a stable regimen it's on autopilot ? Seems like in outpatient specialties the more volume the more profit you generate.

40-50 rheum patients a day would be miserable, and you would be delivering garbage quality care. My partner sees about 30 a day, and he frankly sucks as a rheumatologist. The volume is a big part of why he sucks. You can only cut so much fat before you’re cutting muscle.

That said, I’d do rheum again any day of the week. For me this specialty has been a beautiful combination of lifestyle and compensation after I figured out where to work. I don’t like doing procedures much and I would have been miserable as a GI doc or cardiologist. Making $500k+ working 4.5 days a week/zero call/zero hospital rounds is pretty freaking hard to beat in medicine. Maybe dermatology gets there these days. A/I is close. Maybe concierge PCPs with a full slate of patients, maybe some cash only psychiatrists. That’s about it.

I have a very robust referral stream and I am able to filter out a lot of nonsense to mostly see legit rheumatology patients.

 

[osprey099]

. Making $500k+ working 4.5 days a week/zero call/zero hospital rounds is pretty freaking hard to beat in medicine. Maybe dermatology gets there these days. A/I is close. Maybe concierge PCPs with a full slate of patients, maybe some cash only psychiatrists. That’s about it.

Rads

 

[dozitgetchahi]

Rads

Yeah, rads too. And I kinda liked it as a medical student, and seriously thought about pursuing it for a time. But then I kinda realized that I didn’t want a “medical desk job” and I wanted to actually see patients. I don’t regret that decision.

 

[bronx43]

Rads

Nothing beats rads in terms of the pure metrics. Money? Check. No patient interaction? Check. Option of lifestyle? Check. Live wherever the F you want? Check.

If one likes living in rural areas, then one can very easily do that as rads, while making $800k-1M. If one has to live in a HCOL area, then one can do that, while still being able to pay rent/buy house.

This combination is literally not possible with any other specialty. And no, def not rheum.

 

[bronx43]

this offer isn't so great. 5000 wrvu in hem onc - if legit - is a ton of work even if the patient #s aren't overwhelming. This is 700k worth of work in 2024.

15 onc notes per day is legit worth 700k. I had a brief thought in residency of going into heme/onc... then I saw the notes.

Now I'm stuck in rural. Probably shoulda done those notes.

 

[osprey099]

Nothing beats rads in terms of the pure metrics. Money? Check. No patient interaction? Check. Option of lifestyle? Check. Live wherever the F you want? Check.

If one likes living in rural areas, then one can very easily do that as rads, while making $800k-1M. If one has to live in a HCOL area, then one can do that, while still being able to pay rent/buy house.

This combination is literally not possible with any other specialty. And no, def not rheum.

All of the above is true, but oftentimes people don't realize they work a crapton. One of my best friends is rads. He is non-stop/no break reading films for hours and hours on end. It is actually very mentally taxing work. For clinic based specialties, at least we can take mini-mental breaks here and there (ie zoning out when patients ramble, walking to/from patient rooms, etc)

 

[Legend of Link]

40-50 rheum patients a day would be miserable, and you would be delivering garbage quality care. My partner sees about 30 a day, and he frankly sucks as a rheumatologist. The volume is a big part of why he sucks. You can only cut so much fat before you’re cutting muscle.

That said, I’d do rheum again any day of the week. For me this specialty has been a beautiful combination of lifestyle and compensation after I figured out where to work. I don’t like doing procedures much and I would have been miserable as a GI doc or cardiologist. Making $500k+ working 4.5 days a week/zero call/zero hospital rounds is pretty freaking hard to beat in medicine. Maybe dermatology gets there these days. A/I is close. Maybe concierge PCPs with a full slate of patients, maybe some cash only psychiatrists. That’s about it.

I have a very robust referral stream and I am able to filter out a lot of nonsense to mostly see legit rheumatology patients.

I can never do GI or Cards, don't want any of that lifestyle, done with the stupid rat race.
Why do you think rheumatology is better than A/I? Also can a gig like yours be found in the suburbs of a major metro, especially east or west coast metro?

 

[Legend of Link]

Nothing beats rads in terms of the pure metrics. Money? Check. No patient interaction? Check. Option of lifestyle? Check. Live wherever the F you want? Check.

If one likes living in rural areas, then one can very easily do that as rads, while making $800k-1M. If one has to live in a HCOL area, then one can do that, while still being able to pay rent/buy house.

This combination is literally not possible with any other specialty. And no, def not rheum.

Idk if you are getting a grass is greener feeling tho. Knew one rads in pp who was pulling 800k for two years. Said he won't do it ever again. Took a chiller job for 300k. Previously was reading from his home. He would read images from 6am-9pm. He said there were days when he would just had to hold on off going to the restroom to pee for hours just because so many time sensitive readings were coming in. Was reading at times 300 images per day. Everyday was like taking a step exam.

 

[bronx43]

I can never do GI or Cards, don't want any of that lifestyle, done with the stupid rat race.
Why do you think rheumatology is better than A/I? Also can a gig like yours be found in the suburbs of a major metro, especially east or west coast metro?

Very very unlikely to find shared infusion money in the suburbs of a major metro. If there was, I would have taken it.

 

[bronx43]

Idk if you are getting a grass is greener feeling tho. Knew one rads in pp who was pulling 800k for two years. Said he won't do it ever again. Took a chiller job for 300k. Previously was reading from his home. He would read images from 6am-9pm. He said there were days when he would just had to hold on off going to the restroom to pee for hours just because so many time sensitive readings were coming in. Was reading at times 300 images per day. Everyday was like taking a step exam.

I guess maybe it’s grass is greener syndrome but I’ve never met a rads that wasn’t happy in his or her specialty choice.
You can also go to the rads forum and ask them. None say they rather have done a medicine specialty.

 

[RustBeltOnc]

to OP: hematology oncology is only a "life style specialty" if you compare the ratio of dollars earned:clinic/call time to say neurosurgery etc.

However, there are several factors that make community hematology oncology not a life style specialty:

1. the competition for patients. There isn't really a shortage of oncologists. There's a shortage of qualified people to do all the things large hospital systems want for what they are willing to pay. There's only so many compliant, well-adjusted people with symptomatic FL or stage III colon cancer.

2. Level 6 patients. Lots of work, sometimes patient and families are grateful. Often not so much. My peeps in practice know what I'm talking about. Medical students and trainees? You're going to have to live and learn.

3. Related to #2: unrealistic patients and family members.

4. "I'm going to the university for a second (or third/fourth/fifth) opinion." Patient then returns to local clinic and complains that University said same thing you did and complains about waiting in their office forever etc.

5. Documentation hassles.

I could go on. But no, community hematology oncology is not a lifestyle specialty.

 

[Doc mu]

I guess maybe it’s grass is greener syndrome but I’ve never met a rads that wasn’t happy in his or her specialty choice.
You can also go to the rads forum and ask them. None say they rather have done a medicine specialty.

That's because they are already a highly self selected group, these people work their butts off when on and I think AI and its exponential growth is problematic for such fields

 

[Ubba]

That's because they are already a highly self selected group, these people work their butts off when on and I think AI and its exponential growth is problematic for such fields

From what I've seen so far, AI is a joke.

 

[Doc mu]

There isn't really a shortage of oncologists. There's a shortage of qualified people to do all the things large hospital systems want for what they are willing to pay. There's only so many compliant.

Can you expand on what the hospitals expect?

 

[osprey099]

to OP: hematology oncology is only a "life style specialty" if you compare the ratio of dollars earned:clinic/call time to say neurosurgery etc.

However, there are several factors that make community hematology oncology not a life style specialty:

1. the competition for patients. There isn't really a shortage of oncologists. There's a shortage of qualified people to do all the things large hospital systems want for what they are willing to pay. There's only so many compliant, well-adjusted people with symptomatic FL or stage III colon cancer.

2. Level 6 patients. Lots of work, sometimes patient and families are grateful. Often not so much. My peeps in practice know what I'm talking about. Medical students and trainees? You're going to have to live and learn.

3. Related to #2: unrealistic patients and family members.

4. "I'm going to the university for a second (or third/fourth/fifth) opinion." Patient then returns to local clinic and complains that University said same thing you did and complains about waiting in their office forever etc.

5. Documentation hassles.

I could go on. But no, community hematology oncology is not a lifestyle specialty.

There is definitely a shortage of oncologists. As long as we have a good 30-40% of graduating fellows willing to drink the academia kool-aid, there will always be a shortage of community oncologists. There will only be more cancer patients and there will be even more therapies/complexities coming out in the future. In fact, the trend is going towards biologics, immunotherapies, targeted tx, cellular tx, etc instead of traditional chemo (all of which pays significantly more than chemo btw). Think about CAR-T for primary refractory DLBCL, EV/pembro 1L for bladder cancer. There will also be more market share for patients. What I mean by this is that medical oncology has taken a significant market share in what was previously surgical onc or radiation onc territory. Think about the neoadjuvant chemoIO options for early stage lung cancer. Even 5 years ago, surgical onc owned these group of patients. Now medical onc have their "hands" in the pot.

As long as pharma companies keep up the lobbying on Capital Hill and we don't have an extremely progressive left wing Congressional majority, oncology should be fine for the near term.

 

[Ubba]

There is definitely a shortage of oncologists. As long as we have a good 30-40% of graduating fellows willing to drink the academia kool-aid, there will always be a shortage of community oncologists. There will only be more cancer patients and there will be even more therapies/complexities coming out in the future. In fact, the trend is going towards biologics, immunotherapies, targeted tx, cellular tx, etc instead of traditional chemo (all of which pays significantly more than chemo btw). Think about CAR-T for primary refractory DLBCL, EV/pembro 1L for bladder cancer. There will also be more market share for patients. What I mean by this is that medical oncology has taken a significant market share in what was previously surgical onc or radiation onc territory. Think about the neoadjuvant chemoIO options for early stage lung cancer. Even 5 years ago, surgical onc owned these group of patients. Now medical onc have their "hands" in the pot.

As long as pharma companies keep up the lobbying on Capital Hill and we don't have an extremely progressive left wing Congressional majority, oncology should be fine for the near term.

This is a topic unrelated to the focus of this thread, but it seems that the marriage of oncology's financial ROI to the success enjoyed by the pharma sector places it in a precarious position. Political actors aside, the US is in for a very hard landing when the debt bill comes due. Nobody has any idea when that will happen, of course.

 

[osprey099]

This is a topic unrelated to the focus of this thread, but it seems that the marriage of oncology's financial ROI to the success enjoyed by the pharma sector places it in a precarious position. Political actors aside, the US is in for a very hard landing when the debt bill comes due. Nobody has any idea when that will happen, of course.

IMO, it's not precarious at all. Other sectors and Congress are happily financially married. Look at the military industrial complex and semiconductors. Why can't healthcare also be?

Oncology is more immune than other specialties because of big pharma's dollars and presence. It just so happens that cancer therapeutics make up a majority of most pharma companies' inventory and market share. Physicians always lament that there's no representation and about CMS cuts. Well, big pharma is the entity that has the time, energy, money and power to lobby on our behalf.

 

[RustBeltOnc]

Back to the original topic and the so-called "shortage" of oncologists and how we are compensated.

Most hospital systems (and most of you will be working for hospital systems) don't recognize the cost of the systemic therapy in your compensation. Your comp is largely dictated by supply/demand factors which in turn are heavily influenced by geography. Why is it a new grad who wants to do community hematology oncology on the mainline in Philly makes probably 60% what new grad does 40 minutes outside of Erie? Nivolumab costs the same at each place. Indirectly, because private practice still exists, the price of the drugs does influence compensation but it's a secondary factor.

In regards to "lifestyle." Remember, hospital systems first and foremost prioritize "access" for patients. This is good if it's Hodgkin's patient. It's frustrating when it's fibromyalgia patient with platelet count 115. Also, remember hospital systems also prioritize getting as many patients as possible and keeping patients from going elsewhere. This leads to "outreach" clinics that aren't fully utilized and oncologist that isn't fully utilized. And lastly, inpatient call needs to be covered, in some capacity and while interesting in an academic center, it's much less so in community-based facility.

So, for all of these reasons, there is attrition in community hematology oncology, but not true "shortage" and for same reasons (and others I previously discussed), is not a "life style" specialty.

 

[Doc mu]

IMO, it's not precarious at all. Other sectors and Congress are happily financially married. Look at the military industrial complex and semiconductors. Why can't healthcare also be?

Oncology is more immune than other specialties because of big pharma's dollars and presence. It just so happens that cancer therapeutics make up a majority of most pharma companies' inventory and market share. Physicians always lament that there's no representation and about CMS cuts. Well, big pharma is the entity that has the time, energy, money and power to lobby on our behalf.

You're assuming big pharmas interests align with ours, they would benefi far more if they could dispense onco drugs like other drugs and make the extra cash themselves

 

[geniusindisguise]

You're assuming big pharmas interests align with ours, they would benefi far more if they could dispense onco drugs like other drugs and make the extra cash themselves

No groups will ever perfectly align, but there certainly is some overlap in so far as increased market share from big pharma's standpoint more or less means increased demand for oncologists, especially with the current focus in drug development being moving drugs into neoadjuvant/adjuvant settings, intensifying therapies with upfront combos, and increased downstream imaging/labs/visits, etc. Onco drugs are on another level in terms of toxicity and I don't see any breakthrough drugs with decent efficacy and benign tox profiles being approved any time soon (closest we have is maybe osi), so I don't foresee any major changes in the near future that lead onco therapeutics to be dispensed like other drugs.